Reporting Mistreatment
and Self-neglect
of At-risk Adults
The Who, What, Why, When, and Where
Arapahoe County
Adult Protective Services
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Who are At-risk Adults?
At-risk adults are persons 18 years of age or older who
are susceptible to abuse, neglect, or exploitation because
they are unable to obtain services necessary for their
health, safety, or welfare, or lack sufficient understanding
or capacity to make or communicate responsible
decisions.
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What Conditions May Increase an
Adult’s Risk?
Conditions that may substantially decrease an adult’s
ability to provide for his or her own health, safety, or
welfare may include:
• Dementia
• Developmental disabilities, including Cerebral Palsy,
Autism, and mental retardation
• Brain injury
• Behavioral disorders
• Mental illness
• Physical frailty
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What is Mistreatment?
In Colorado, “mistreatment” refers to an act (or
omission of an act) that threatens the health, safety, or
welfare of an at-risk adult, or that exposes the adult to
a situation or condition that poses an imminent risk of
death, serious bodily injury, or bodily injury to the
adult.
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Mistreatment includes:
• Caregiver Neglect
• Physical Abuse
• Sexual Abuse
• Self-abuse
• Financial Exploitation
• Other Forms of Exploitation
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What is Self-neglect?
Self-neglect is an act or failure to act whereby an at-risk
adult substantially endangers his or her health, safety,
welfare, or life by not seeking or obtaining services
necessary to meet his or her essential human needs.
Please note: Choice of
lifestyle or living
arrangements, by itself,
is not evidence of self-neglect.
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Self-neglect is the most commonly reported concern
regarding at-risk adults.
The reasons at-risk adults may self-neglect range from
lifestyle choice, to lack of knowledge about available
services, to sensory or medical impairments that affect
decision making.
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If the adult chooses not to clean his home or
not to take her prescribed medications, and has
the decisional capacity to make such decisions,
he or she has the right to continue making
such choices without intervention.
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If the level of selfneglect is a violation
of the law, such as
with housing more
animals than a city
ordinance allows, the
at-risk adult may be
required to take
actions to come into
compliance with the
law.
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Why is it important to report?
At-risk adults are often unable and are
unlikely to report mistreatment
and self-neglect, which is why
it is imperative that community
members and service professionals
learn to recognize and report abusive,
exploitive, and neglectful behaviors involving at-risk adults.
It is estimated that less than 1 in 6 cases of mistreatment
of at-risk adults is reported to the proper authorities.
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Mandated Reporting and APS
•
•
•
•
Began July 1, 2014
Adults age 70 or older
Abuse, neglect or exploitation
Reports are made to local law enforcement
within 24 hours
• Professionals mandated to report
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Who is mandated to report?
• PHYSICIANS, SURGEONS, PHYSICIANS'
ASSISTANTS,OSTEOPATHS, PHYSICIANS IN TRAINING,
PODIATRISTS, OCCUPATIONAL THERAPISTS, AND PHYSICAL
THERAPISTS;
• MEDICAL EXAMINERS AND CORONERS;
• REGISTERED NURSES, LICENSED PRACTICAL NURSES, AND
NURSE PRACTITIONERS;
• EMERGENCY MEDICAL SERVICE PROVIDERS;
• HOSPITAL AND LONG-TERM CARE FACILITY PERSONNEL
ENGAGED IN THE ADMISSION, CARE, OR TREATMENT OF
PATIENTS;
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Mandated reporters
• CHIROPRACTORS;
• PSYCHOLOGISTS AND OTHER MENTAL HEALTH
PROFESSIONALS;
• SOCIAL WORK PRACTITIONERS;
• CLERGY MEMBERS;
• DENTISTS;
• LAW ENFORCEMENT OFFICIALS AND PERSONNEL;
• COURT-APPOINTED GUARDIANS AND
CONSERVATORS;
• FIRE PROTECTION PERSONNEL;
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Mandated Reporters
• PHARMACISTS;
• COMMUNITY-CENTERED BOARD STAFF;
• PERSONNEL OF BANKS, SAVINGS AND LOAN
ASSOCIATIONS, CREDIT UNIONS, AND OTHER
LENDING OR FINANCIAL INSTITUTIONS; AND
• A CARETAKER, STAFF MEMBER, OR EMPLOYEE OF
OR VOLUNTEER OR CONSULTANT FOR A LICENSED
OR CERTIFIED CARE FACILITY, AGENCY, HOME, OR
GOVERNING BOARD, INCLUDING BUT NOT LIMITED
TO HOME HEALTH PROVIDERS.
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Any Other Person May Report.
According to Colorado law, “Any other person may
report known or suspected mistreatment or self-neglect . . .
to local law enforcement or [to] the county department.”
This includes family members, neighbors, friends, and any
other persons suspicious that an at-risk
adult is being subjected to mistreatment or that the adult is
engaged in self-neglecting behavior.
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When and Where Do I Report?
If you suspect mistreatment or self-neglect of an at-risk
adult, immediately report the situation to the County
Department of Human (Social) Services in the county where
the adult lives. Ask to speak to:
“Adult Protection Intake”
If calling about an emergency situation during non-business
hours, contact law enforcement to make the report.
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When making a report, please have as much of the
following information ready to provide to APS as
possible:
• Adult’s name, address, current location, phone, and
date of birth or approximate age;
• The circumstances that cause you to suspect that
mistreatment or self-neglect are occurring;
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And the following information:
• When appropriate, the suspected perpetrator’s name,
address, and relationship to the adult; and
• Additional information about the adult, if available,
such as his or her doctor, caregiver, attorney,
guardian, or other person of significance to the adult.
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The Adult Protective Services (APS)
intake person will ask for
information about the adult, the
situation, and other pertinent
details.
It’s okay to make a report to APS
even if you are not able to answer
all of the questions.
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Confidentiality and Reporting
The identity of a person reporting concerns about an
at-risk adult to APS is confidential. If the reporter
chooses, he or she may remain anonymous when
making a report to APS.
However, it is very helpful to APS if the reporter
provides some means by which the caseworker can
re-contact him or her for additional information.
Getting additional information from the reporter may
help APS to provide a better outcome for the at-risk
adult.
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Reporter Liability
Some APS investigations result in
findings that the alleged
mistreatment or self-neglect are not
occurring as suspected by the
reporter.
If the reporter believed the person was at-risk and in
danger and he or she made the report in good faith,
there is no liability to the reporter should the information
provided turn out to be false or incomplete.
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False Reporting
If a person intentionally makes a false report of
mistreatment or self-neglect of an at-risk adult that he
or she knows is not true, that person has committed a
crime in Colorado and is subject to criminal
prosecution.
If found guilty, the person who
made the false report could be
fined up to $750, or receive a jail
sentence of up to 6 months in jail,
or BOTH.
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What Happens When I Report?
Each report made to Adult
Protective Services (APS) is
assessed by a caseworker
and/or APS supervisor.
In many counties a team of
professionals reviews the
referral in a RED (Review,
Evaluate and Direct) team
process.
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RED TEAM
•
Review, Evaluate, Direct
The referral acceptance decision is a very crucial initial step that
is made regarding the safety of children after a report is made
to the Department. Traditionally this has been the decision of
one or two people reading and reviewing reports then making
the decision whether it should be assigned.
A Team Decision Making model was implemented which
provides a structured format for reviewing all referrals. The
team includes representation from all areas across the
Department. ACDHS established a structured framework and
process to review alleged reports of child maltreatment,
evaluate the available information and give direction regarding
the agency response.
Our experience has shown that this model works and provides a
more in depth analysis to determine the Department’s role and
resources for the family.
What Does the RED Team Decide?
•
Does the report of alleged mistreatment meet the statutory threshold
for intervention?
•
If so, what is the appropriate response time?
•
If it does not meet the threshold of adult protection intervention,
should it be referred for community services?
What is the Role of APS
In Colorado, Adult Protective Services (APS)
caseworkers seek to arrange for services for consenting
at-risk adults to help ensure the adult’s health and
safety is protected.
Caseworkers may assist at-risk adults for whom actual
or potential risk exists from mistreatment or selfneglect.
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APS Priorities
When providing protective services, APS strives to
secure the safety and protection of the at-risk adult and
to ensure, as much as possible, that each case is
handled with priority given to the following aspects of
case management.
•Confidentiality
•Consent
•Self-Determination
•Least Restrictive Intervention
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Confidentiality
The adult’s confidentiality is a high priority outlined by Section
26-3.1-102(7)(b) C.R.S., which states that all case information
reported to APS is confidential.
This includes information such as:
•
The adult’s name and address;
•
The names & addresses of the adult’s family members;
•
The name of the person making the report;
•
The allegations of mistreatment or self-neglect; and
•
Other identifying information.
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Confidential information regarding a report of mistreatment
or self-neglect of an at-risk adult may only be disclosed when
a court, for good cause, orders the information released;
• A criminal complaint, information, or indictment based
on the report is filed;
• There is a death of a suspected at-risk adult from
mistreatment, self neglect, or exploitation and a law
enforcement agency files a formal charge or a grand
jury issues an indictment in connection with death;
• Such disclosure is necessary for the coordination of
multiple agencies’ investigation of a report or for the
provision of protection services to an at-risk adult.
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Under any other circumstance,
the release of confidential APS
information is illegal; and is
punishable by a fine of up to
$300.
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Consent
The adult’s consent is another high priority. Its
importance is underscored by Section 26-3.1-104(1),
C.R.S., which states:
“[If] an at-risk adult is being mistreated or selfneglected, or is at risk thereof, and the at-risk adult
consents in writing to protective services [ongoing
protective services may be provided].”
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If the adult refuses
APS assistance and
appears capable of
understanding the
consequences of
doing so, the
caseworker will leave
APS contact
information, if
possible, and will not
be further involved.
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If an adult appears incapable of making important
decisions, APS may seek professional assistance to
establish the adult’s decision-making capacity in order
to better protect the safety of the adult. This may
require professional medical and court involvement.
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Self -Determination
Self-determination is another priority of APS
service provision. Traditionally, selfdetermination refers to a person’s ability to
exercise deliberate control over his or her
activities of daily living, including lifestyle
choices.
Self-determination especially
pertains to an at-risk adult’s choices
regarding which, if any, protective services
to accept.
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Least Restrictive Intervention
Least restrictive intervention is another high
priority for APS and involves planning an
intervention that will cause the minimum
disruption possible to the adult’s life.
APS is sometimes called upon to help an adult
remain in his or her own home by arranging for
assistance in the home or by the assignment of a
representative payee to assist with monthly bills,
such as past-due rent or mortgage payments.
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Guardianship
• County APS programs are not required to
petition for guardianship or to become an
adult’s guardian. Each county establishes it’s
own policy.
• In all cases, county APS programs are
guardians of last resort.
• Clients are entitled to make their own
decisions until a court determines they lack
the ability to make decisions that adequately
provide for their physical health, safety, or
welfare.
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Guardianship
• Guardianship is not a “quick fix” to solve
problems with patient decision-making. It
takes many weeks from initial involvement to
court hearing.
• Emergency guardianships are pursued when
there is potential for substantial harm to the
client and there is no one with the authority to
act on behalf of the person’s best interests.
• Emergency guardianship may take days to a
week or more.
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Guardianship
• APS cannot petition for guardianship solely to make
medical decisions.
• Alternatives:
Medical Durable POA
Proxy Decision Maker
Even a guardian cannot:
impose mental health treatment or medications,
impose alcohol or drug addiction treatment ;
or place an adult with a developmental disability in a
regional center.
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Arapahoe County APS
Crisis Intake Hotline:
303-636-1750
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